Application
Outstanding Undergraduate Student Award
Application Due: Friday, March 11, 2016
Period of Accomplishments: January 1, 2015 – December 31, 2015
Applicant's Name: - Please type applicant's name here Mailing Address:
Email address:
Phone:
Applicant’s major and concentration:
- Please type major hereSignature of Applicant: ________________________________________ Date: ___________
Date received: ________________________________
Received by: _________________________________________________________________
Supporting Documentation
Grade Point Average (4.0 scale):
 In the text box below, please enter the overall grade point average (on a 4.0 scale).
o 3.00 – 3.25 = 1 point
o 3.26 – 3.50 = 2 points
o 3.51 – 3.75 = 3 points
o 3.76 – 4.00 = 4 points
GPA = None
Extracurricular Activities: (Maximum of 6 points)
 In the text box below, please list affiliations with professional/student organizations, offices held in
professional organizations, offices in Student Government Association, and community service. The
text box will expand as you type.
None
References: (Maximum of 6 points)

This award application package must include three evaluation forms from individuals who can
evaluate the applicant’s efforts. At least one reference must be from a faculty/staff member in a
discipline other than that of the applicant. Reference form is at the end of this document.
In the box at the left, please enter the number of letters included in this award application
packet.
Please provide names and contact information in the text box below. The text box will
expand as you type.
- Please enter the name, mailing address, telephone, and e-mail address of each reference
here Personal Statement: ( Maximum of 6 points)
 Brief statement concerning current involvement in the profession and future contributions.
Statements must be at least 500 words.
Presentations: (Maximum of 4 points)
 In the text box below, please type a complete reference [author(s), year of publication, title, meeting
organization, meeting location, meeting date(s)] for each presentation to be evaluated for this
application packet. The text box will expand as you type.
 For each presentation, you must also include and clearly indicate the following information:
o The type of meeting (professional or non-professional; international, national, or local)
o Whether the presentation was oral or poster
o Whether the presentation was refereed or non-refereed
o Whether the presentation was on-campus or off-campus
None
Awards: (Maximum of 4 points)
 In the text box below, please type a list of awards received during the period of accomplishments.
The text box will expand as you type.
 For each award, you must include the following information:
o The name of the award
o The awarding organization
o The date of the award
o The type of award (professional or non-professional; international, national, or local)
None
Publications: (Maximum of 4 points)
 A reprint or copy of each publication must be included as a supporting document in this application
packet.
 In the text box under the appropriate category below, please type a complete reference [author(s),
year of publication, title, publisher] for each publication supporting document included in this
application packet. The text boxes will expand as you type.
o
Refereed Publications:
None
o
Non-Refereed Publications:
None
o
Magazine Articles:
None
o
Newspaper Articles:
None
o
Abstracts:
None
o
Proceedings:
None
o
Books:
None
o
Book Chapters:
None
o
Bulletins:
None
o
Other:
None
Submit application form and supporting materials electronically to:
De’Etra Young
dyoung23@tnstate.edu
.
Student Reference Sheet
Student
Evaluator
__________________________
Date ______________
__________________________
In what capacity do you know the student?
Attribute
Academic performance
Professionalism
Character
Creativity
Ambition
Perseverance
Interest in sharing ideas
Initiative/self motivation
Ability to work with others
Ability to meet deadlines
Ability to assimilate new
information
Ability to accept criticism
Verbal skills
Writing skills
Additional Comments:
Excellent
(4)
Good
(3)
Average
(2)
Below Average
(1)